Sharing Current Scottish Practice

This blog provides an opportunity for people to share examples of current Scottish
palliative care practice that might be of interest to the palliative care community more widely. If you
know of work underway that might be relevant for sharing on our website, please get in touch.

The SPPC Annual Conference in 2017 featured 46 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on five of these:

This poster will present the development of
Roseberry End of Life Care and Choices: A person-centred end of life care
plan for people with dementia, their carers and their nurses.

A pilot study was conducted within an NHS
in-patient mental health specialist unit for women experiencing stress and
distress from advanced dementia, including in the last stages of their
illness.

Quality improvement with co-production
methodology was used to develop and test the approach and documentation. Quantitative data and qualitative feedback
including focus groups and questionnaires captured the experience and impact
on people with dementia, carers and staff.

A two-part document was devised, a care plan
where carers share information with staff regarding the person and
Information for You to support staff sharing information about the dying
process with carers. A three-stage
process of care and support has been tested and adopted, an initial meeting,
use of the care plan at end-of-life and a follow-up phone call to the carer
3–4 weeks after a death.

Socioeconomic status is associated with
place of death in patients known to hospice services

Author(s)

Sarah Bowers; Maire O'Riordan; Mike
MacFarlane; Emma Carduff

Background:
Place
of death is a priority to patients and relatives at the end of life with most
choosing home, yet 58% of Scottish deaths occur in hospital. Studies suggest
that those living in deprivation are less likely to die at home.

Aim: To describe the
relationship between place of death and socioeconomic status for patients
known to a hospice over a 5-year period.

Method:
Scottish
Index of Multiple Deprivation (SIMD, 2016) was used to group. Place of death
was examined for each deprivation quintile (DQ). Deaths where location was
unknown or in a nursing home were excluded.

Results:
Of
4585 patient deaths 41% died at home, 40% in the hospice and 19% in hospital.
Deaths at home were lower in the most affluent group. There was a highly
significant direct relationship between DQ and the proportion of patients
dying in the hospice. There was an inverse correlation between DQ and the
proportion dying in hospital.

Conclusion:
Overall,
this study demonstrates that patients from more deprived areas, known to the
hospice, are still more likely to die in hospital than their more affluent
counterparts. This is potentially inequitable, does not necessarily reflect
need and has resource implications.

Testing a WISeR approach to community
palliative care

Author(s)

Susanne Gray; Jackie Mearns; Cathy Quinn;
Katie Clark; Alison McGill

Many people in Scotland who could benefit
from palliative and end of life care (PEOLC) do not receive it. The Strategic
Framework for Action on PEOLC aims to ensure that by 2021 everyone who needs
palliative care will have access to it.

We sought to reduce variability in community
palliative care (all settings and conditions), testing ways to develop a
consistent response, that gives people and their families the opportunity to
identify and discuss their concerns and plan ahead if they wish.

Aiming to promote equal opportunities for
holistic person centred assessment via the introduction of a model that
identifies and streams people with palliative care needs offering a
proactive, coordinated, integrated model for palliative or any complex care
that is fit for the future. We worked with GPs and health and social care
services using a 'Plan-Do-Study-Act' (PDSA) approach to test and refine a new
weekly multi-disciplinary team resource and allocation meeting (Weekly Integrated
Standard Response - WISeR palliative care). We used focus groups and
observation to collect qualitative data for evaluation.

Outcomes included:


improved integrated working


improved access to assessment and services


crisis prevention


improved communication.

Further testing is required to confirm
results and evaluate the impact on patients and carers as well as staff.

The barriers and facilitators to
implementing the Carer Support Needs Assessment Tool (CSNAT) in a community
palliative care setting

Family carers play a central role in
community-based palliative care. However, caring for a terminally ill person
puts the carer at increased risk of physical and mental morbidity. The
validated Carer Support Needs Assessment Tool (CSNAT) provides a
comprehensive measure of carer support needs and is intended for use in
community palliative care. The CSNAT creates an opportunity for carers to
discuss their needs with healthcare professionals, facilitating the provision
of appropriate support. A recent audit demonstrated poor use of the CSNAT in
a Scottish community specialist palliative care service despite training and
support.

Research Aim: To identify barriers and
facilitators to implementation of the CSNAT in a community specialist
palliative care service.

A qualitative study was undertaken, involving
interviews with 12 palliative care nurse specialists from two community
nursing teams in Lothian, Scotland.

Data analysis is ongoing. The poster will
present the results, identifying factors which enable and prevent the use of
the CSNAT in a community palliative care setting. Recommendations for
improving the acceptability of the CSNAT will be developed.

Findings from this study have the potential
to enhance engagement with the CSNAT, make it more congruent with current
nursing practice, and improve the experience of carers of people approaching
the end-of-life.

The decision to undergo palliative
chemotherapy: how do patients feel about the decision making process at the
Edinburgh Cancer Centre?

The aim of this service
evaluation conducted at the Edinburgh Cancer Centre (ECC) was to assess how
people felt, with hindsight, about the decision to have palliative or
curative chemotherapy for lung or gynaecological cancers. The SURE test,
comprising four questions, was adapted for retrospective use with patients
who had completed their treatment and had returned to the oncology clinic. A
fifth question relating to regret was added. Questionnaires were completed in
conversation with a medical student.

29 patients completed the
questionnaire (13 males, 16 females.) Patients generally reported high levels
of certainty that treatment had been the right choice, both at the time of
the decision, and upon treatment completion. Most also reported feeling that
they were supported well with the decision. The lowest scoring areas related
to understanding of treatment risks and benefits.

It is reassuring that most
patients felt confident in the decision making around treatment. Others' work
locally has revealed that regret often comes late, and it is possible that findings
would have been different if patients had been surveyed later. Poor
understanding of risks of treatment could reflect a number of scenarios, and
warrants exploration with future work.

The SPPC Annual Conference in 2017 featured 46 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on five of these:

Background: Metastatic spinal cord compression (MSCC) is
an oncology emergency with a poor prognosis if treated late. Guidelines exist to improve patient
outcomes, however the outcome for many remains poor.

Aim: To report the findings of patients, carers
and healthcare professionals’ perceptions and experiences of managing MSCC.

Methods: A qualitative multiple case study
design. Participants were recruited
from an acute cancer centre and primary care in Scotland. Three focus groups (n=25) and interviews
with healthcare professionals (n=7) were carried out in phase one. Phase two semi-structured interviews
include patients (n=8), carers (n=6) and healthcare professionals (n=42). Patients and carers were interviewed at two
time points. Data were analysed
thematically.

Results: In phase one, healthcare professionals were
‘negotiating the care-pathway’ as existing guidelines lack a strong evidence
base. Phase two revealed a constant movement between uncertainty and enduring
inconsistencies (of information, treatment and advice), which results in a
struggle to find a balance.

Conclusions: Patient’s
preferences are central to managing symptoms where life expectancy is
limited. A theory of collaborative
decision-making is proposed to reduce uncertainty and facilitate
decision-making. The key constructs
are: awareness of signs and symptoms of MSCC, collaborative decision-making,
prioritising and maximising life and end of life care.

Person-centred care – at the heart of what
we do

Katy Simpson

Background: Meeting the
holistic, social, spiritual, psychological and physical needs of our
inpatients, community patients, their families and carers. Through the use of
creative activities, we can provide a robust emotional support service. All of our therapeutic services are provided
within The Margaret Kerr Unit. A study
carried out by The Canadian Counselling and Psychotherapy Association found
that art therapy encourages the development of healthy coping strategies1. This supports our ongoing ‘Public Health Palliative Care’
campaign by raising awareness and engaging with members of the community outwith
The Margaret Kerr Unit and palliative care service.

How? By providing
services to inpatient and community based patients, it provides social
stimulation through enabling them to meet new people and for those out with
the unit, it helps break down the barriers and stigma about the Unit and the
service we provide. Our events are held weekly and bi-annually to coincide
with Dying Awareness Week.

Findings: Patients and families
feel many of their needs are well supported alongside the clinical care they
are receiving. The uptake of these activities continues to grow each week due
to discussions being generated on social media around death and dying
awareness.

Proactive Discharge - a person-centred
approach to wellbeing within a hospice day service

Lynsay Bain; Janice Allan; Ann-Majella
McFadden

Previous feedback demonstrated patients felt
unprepared for discharge from a palliative care day service, Kilbryde Hospice
(KH) staff sought a more effective method to support patients through the
discharge process. A new Wellbeing
Group (WG) was created.

The WG focused on enhancing knowledge and
self-empowerment using a person centred approach. Using self-management
techniques, enabling and empowering patients to make shared decisions and
understand realistic medicine(1).
Creating an inclusive and positive discharge process. This reflects
the Scottish Governments vision of practising Realistic Medicine putting
patients at the centre of decision making.
Outcomes were evaluated through the use of evaluation, Patient
Activation Measure (PAM)(2) and Views on Care (VoC)(3)

'Putting Activity Back into Life: The
Inception of a Wellbeing Group'

Sarah Mitchell

The Day Hospice team at St Vincent's Hospice
(SVH) has been developing an approach which integrates rehabilitation,
enablement, self-management and self-care into the holistic model of
palliative care. This has led to the team delivering a 'Wellbeing Group',
which is the first of its kind in a hospice setting.

The group combines exercise, support and
education, which reflects the well-established and effective format of
cardiac and pulmonary rehabilitation. It aims to allow patients to
maintain/increase functional fitness, become more active, less sedentary and
improve their knowledge of their illness therefore encouraging
self-management.

Six palliative care patients attended an 8
week, 2-hour outpatient programme at SVH. The exercise component consisted
mainly of circuit-based exercise and the 8 educational components covered
topics such as coping with pain, breathlessness and fatigue.

At the end of the programme, the outcome
measures (5 functional fitness tests) showed that every patient had improved
their functional fitness in at least one aspect. Feedback from the patients
was positive and showed they were starting to be more active despite their condition.

The initial Wellbeing Group achieved its
aims. The team acknowledge that future programmes should evaluate the impact
of the educational component to assess the potential impact on
self-management in palliative care patients.

Relational elements of end of life
anticipatory care planning (ACP): implementation in Dumfries and Galloway

Jacqueline Kandsberger

This study explores how ACP is currently
operationalised in Dumfries and Galloway.

GPs from various districts and levels of
urban-rural classification have been recruited. ACP data are being extracted
from the medical records of decedent patients and GPs are completing a survey
soon after the death of each patient, detailing the different elements of ACP
discussions in each case and the associated relational and structural
barriers.

After the first 5 months of the study 64
surveys on expected deaths have been collected across 18 GPs. ACP is a
coherent process to GPs, however, time is a barrier to implementation and
there is insufficient feedback for reflexive monitoring of the process. In
36% of cases patients were open to and capable of discussing ACP and in 67%
family members were involved. Specific treatment wishes and personal
relationships that influence care are examples of elements most often
discussed, while cultural and other values or spiritual beliefs were almost
never part of ACP. In 47% of cases information from ACP discussions changed
the GPs’ care plan and recommendations at least to a small degree. 72% of
patients had a KIS with varying levels of completion and effects on dying in
their preferred place of death.

The SPPC Annual Conference in 2017 featured 46 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on five of these:

How the Living Well in Communities team -
part of Healthcare Improvement Scotland's Improvement Hub - will support six
Health and Social Care Partnerships across Scotland to improve the
identification and care coordination of people with palliative care needs,
fulfilling commitment one of the Strategic Framework for Action for Palliative
and End of Life Care.

Each test site will consider ways to improve
identification of people with a palliative need, develop anticipatory care
planning and test community based models of care that increase opportunities
for both generalist and specialist palliative care in the community.

The improvement programme will run for two
years and learning from the tests of change will be shared during the
lifetime of the programme in the form of learning assets and events.

Palliative and end of life care research in
Scotland 2006 – 2015: A scoping review

Background: The Scottish
Government set out its 5-year vision to improve palliative care in its
Strategic Framework for Action 2016-2021. This includes a commitment to
strengthening research and evidence based knowledge exchange across Scotland.
A comprehensive scoping review of Scottish palliative care research was
considered an important first step.

Method: Five databases were
searched with relevant MeSH (Medical Subject Headings) terms and keywords;
additional papers authored by members of the Scottish Palliative and End of
Life Care Research Forum were added.

Results: In total, 1,919
papers were screened, 496 underwent full text review and 308 were retained in
the final set. The top three areas
were experiences and/or needs; services and settings; and physical symptoms.
58 papers were concerned with palliative care for people with conditions
other than cancer – nearly one fifth of all papers published.

Conclusion: The findings reveal
a considerable increase in palliative care research output over the last
decade when compared with a similar Scottish review in 2006 and the 151
papers identified in a review of Irish palliative care research in 2013. The
Scottish Research Forum in Palliative care will now disseminate key findings
to clinicians, service managers and policy-makers to improve the reach and
quality of palliative care.

Palliative care in the ICU setting

Author(s)

Dr Caroline Burke; Dr Niamh Feely; Dr
Patricia Sheahan

A quality improvement project looking at the
number of deaths in the ICU setting in a peripheral hospital in Kerry,
Ireland in 2016 with regard to the prevalence of referrals to the Palliative
Care Team and analysis of the cases where palliative care referral may have
improved patient care. The problematic nature of providing expert palliation
in critical and acute settings has been well recognised.

What is the definition of a "good
death"? A significant number of
seriously ill patients undergo overly aggressive management, inadequate pain
control and suffer as a result of poor communication. There is huge variation
in the withdrawal and withholding of therapy in European ICUs. This study was
a retrospective chart review. The number of deaths in the ICU in UHK in 2016
was quantified at 40. Charts were
analysed for data: Was the death expected or unexpected? If expected was the
Palliative Care Team involved? If palliative care was not involved could they
have improved care? Was there a missed
opportunity for palliative input? 35 deaths were deemed to be expected. Of
the 35 patients whose deaths were expected there were 9 incidences of
Palliative Care Team involvement. There were 8 missed opportunities for
Palliative Care Team involvement.

Palliative care from diagnosis to death:
developing a rationale

Author(s)

Murray SA; Kendall M; Mitchell G; Moine S;
Amblas-Novellas J; Boyd K

Early palliative care may prolong life as
well as improve its quality, but it is frequently only started in the last
weeks or days of life and largely for people with cancer. Its huge potential to minimise and prevent pain
and distress across illnesses is not realised. This poster shows how early
palliative care may be triggered for people living and dying from different
conditions. It also points out the elements of palliative care that might
often be relevant for people at different points in their illness. Palliative
care might be triggered by non-physical needs which may alter greatly as the
illness progresses.

Palliative intent treatment for head and
neck cancer: an analysis of local practice and outcomes

Author(s)

Finn Begbie; Catriona Douglas; Fiona Finlay; Jenny
Montgomery

Management of head and neck cancer is a
complex area and there is often significant morbidity associated with
treatment. Management options are divided into those given with curative
intent and those given with palliative intent. Palliative treatment,
sometimes described as best supportive care, can involve a wide variety of
treatments. There is little consensus, and indeed a paucity of literature, on
which palliative treatments should be provided for primary head and neck
cancer and predicting outcome remains a grey area. The present study sought to delineate local
practice and outcomes in patients treated with palliative intent in terms of
survival, treatment received and associated morbidity in order to better
inform treatment decisions in the palliative management of head and neck
cancer.

The SPPC Annual Conference in 2017 featured 46 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on six of these:

Background:
A
joint hospice approach to expand the Clinical Nurse Specialist Service,
enabling access to nurse specialist palliative support 7 days per week. This
supports existing NHS services at weekends, providing additional palliative
care expertise to patients, families and professionals and integrating with
the Marie Curie Nursing Service.
Existing funding was re-allocated to test this model prior to
embedding into business as usual.

Aim: The service targeted
inequity of provision of specialist palliative care out of hours and reduce
avoidable admissions at weekends.

Methods:
The
CNS service was delivered over 7 days, offering telephone advice and support
+/- a home visit. A mixed-methods
methodology was used to analyse service use and outcomes of the pilot.
Stakeholder, healthcare professional and service user surveys were carried
out to review service acceptability and quality. Analysis of activity levels was used to
assess the impact on the service. Economic analysis was undertaken to
estimate potential savings from implementation of the model.

Results:
The
evaluation evidenced improved quality outcomes for patients and a change in
hospice inpatient usage. Significant reduction in admissions to hospital or
hospice with a positive return on investment. Patients and carers had a service
satisfaction rating of 94%.

Conclusion:
The
integrated service model demonstrates that investment in coordinated
specialist palliative care services across seven days, delivered in
partnership, results in positive outcomes in quality of care and health
economics.

Is palliative care appropriate for people
with major stroke?

Background:
Case
fatality after total anterior circulation stroke (TACS) is high. Our
objective was to describe the experiences and needs of patients and carers,
and to explore whether, and how, palliative care should be integrated into
stroke care.

Methods:
Mixed-methods.
We recruited a purposive sample of people with TACS from three Scottish
stroke services, and conducted serial, qualitative interviews with them and
their informal and professional carers at six weeks, six months and one year.
Interviews were transcribed for thematic and narrative analysis. A data linkage study of all TACS patients
admitted to these services over six months recorded case fatality, place of
death and readmissions.

Findings:
Data
linkage (n=219) showed that 57% of TACS patients died within six months. We conducted 99 interviews with 34 patients
and their informal and professional carers. Patients and carers faced death
or a life not worth living. Those who survived felt grief for a former life.
Professionals focussed on physical rehabilitation rather than preparation for
death or limited recovery. Future
planning was challenging. ‘Palliative care’ had connotations of treatment
withdrawal and imminent death.

Interpretation:
Major
stroke brings likelihood of death but little preparation. Realistic planning with patients and
informal carers should be offered, raising the possibility of death or
survival with disability. Practising the principles of palliative care is
needed, but the term “palliative care” is unhelpful.

Is Scotland ready to create its own day of
the dead?

Author(s)

Rebecca M Patterson; Mark A Hazelwood

Aims
and background: This
work aimed to test whether, in Scotland, a national community-based festival
of storytelling and remembrance is a culturally acceptable way of building
individual and community resilience in dealing with loss.

Social and personal support mechanisms are
important in helping people to cope with bereavement, yet religious and/or
community-based support networks are non-existent for many. People want to
support others through bereavement, but often struggle to know how. Rituals
of remembrance can build solidarity, yet many traditions relating to the
expression of loss have faded.
Improving experiences of bereavement is part of a public health
approach to palliative care.

Design,
methods and approach taken: A clear approach to developing the festival
was established, drawing on authors’ previous work, relevant literature, and
experiences of bereaved people and bereavement specialists. To Absent Friends (TAF), a people’s
festival of storytelling and remembrance was planned for 1-7 November 2014
and 2015. Carefully designed resources
including website, film, leaflet and participation ideas were produced to
encourage participation. These were promoted via the professional and personal
networks of the authors and media.
Quantitative and qualitative data for evaluation of TAF 2015 was
gathered via online survey of participants; structured questionnaire to event
organisers; web and social media metrics; direct observation.

Results:
In
2015 over 5000 people participated, from a broad variety of organisations and
demographics. 1.75 million were
exposed to the festival via the media.
98% of survey respondents reported taking part was a positive
experience. Qualitative responses
indicate that participation was of deep significance for many.

Conclusion/Lessons
learned: The
festival is an acceptable approach and enthusiasm exists in Scotland to
create a time of year when remembering dead loved ones is socially accepted
and supported within mainstream culture.

"Living Right up to the End" What
people with long term conditions want to support them to plan ahead

Author(s)

Susan High; Dr Sally Boa; Marjory Mackay

National policy encourages people with Long
Term Conditions (LTCs) to plan for end of life. People seem reluctant to do
this. The “Living right up to the end” project aimed to find out what was
important to people in the last year of life in relation to planning ahead,
and what would support them to do this.

We held 18 engagement events in local venues.
People with LTCs and their carers were asked

- What matters to you when you are living with declining
health?

- What prevents you
making plans for the future?

Direct quotes were analysed using framework
analysis. The findings were verified at two further engagement events

We found maintaining control, having a plan,
important conversations and access to appropriate information were what
mattered to people

Barriers to planning ahead included cost,
lack of information, lack of social support and uncertainty.

We worked with groups of people with LTCs to
co-produce an information pop up stand with resources to help with planning
ahead and having difficult conversations. The stands have been tested in
local venues and manned by volunteers from the local community with personal
experience of LTCs.

We are working with people with LTCs to
evaluate this intervention.

More Care Less Pathway approach to end of
life care

Author(s)

Gerry Finnan

Following the publication of the More Care Less Pathway report The Liverpool Care Pathway (LCP) was
withdrawn from use within Scotland by the Scottish Government (SG) in 2014. Later in 2014 the SG published guidance on
end of life care Caring for people in
the last hours and days of life but no care plan to replace the LCP was
introduced. Following consultation with major palliative care groups across
Scotland a Strategic Framework for
Action on Palliative and End of Life Care was published by the SG early
2016 which stated their commitment to work with partners to ensure that high
quality palliative and end of life care is available to all who can benefit
from it.

The Care
Record for End of Life (CREOL) was developed by the palliative care team
within the Margaret Kerr Unit to help achieve high quality accessible end of
life care across NHS Borders. The CREOL is a record of care delivered to
patients at end of life and is not a tick box exercise or rigid process or
procedure to be followed. It can be
used to promote discussion of diagnosis of dying between clinicians and the
wider multidisciplinary team and promotes clear concise communication between
clinicians, patient and family or carers. This poster presents the new
document which has been trialled for 12 months in the palliative care unit
within Borders General Hospital.

Moving
towards a vision of Person Centred Culture (PCC) across the hospice: do all
eyes see the same truth?

Background: Over a 2 year period
from-2015-2017, Queen Margaret University (QMU) facilitated a programme of
practice development with a key group of multi-professional clinical and
non-clinical staff. The Person-centred Practice Framework developed and
updated by McCormack and McCance in 2016, continues to guide this on-going
programme of work.

Aims: The overall aim was
to move towards a shared vision of person-centred culture that focused
strongly on people’s individual beliefs and values, processes and the care
environment.

Methods: Transformational
methods demonstrating the principles of practice development (McCormack et al
2013) were used to create and define the person-centred vision and to explore
and evaluate person-centred culture.
Evaluation methods included staff and patient stories and observations
of care and environment. Facilitated
events also took place to explore workplace culture, relationships and
practices within designated teams.

Conclusion: The person-centred
processes that have been used in all aspects of the work have proven to be
effective will continue through active facilitation and integration within
all areas of the hospice in the future.

The SPPC Annual Conference in 2017 featured 46 poster displays, sharing work and research underway across Scotland. Each month, this blog focuses on the content of a few of these posters. This month, we focus on six of these:

Enriching & Improving Experience

Authors

Jane Andrew; Elaine Colville; Elizabeth
Sanchez-Vivar

A framework to support the learning and
development needs of the health and social service workforce in Scotland”
(2017) We took an integrated collaborative approach to identify the knowledge
and skills required by all health and social service workers in palliative
and end of life care. We consulted widely with health and social service
workers, palliative care experts, educators and other partners in cyclical
co-design approach. The structure and content was informed by evidence
gathered from, scoping exercise, rapid review of literature, mapping of
existing frameworks, workforce focus groups, online learning needs survey,
expert and reference group opinion, workforce consultation events and online
workforce consultation. Results: Five domains reflect the core knowledge and
skills integral to the delivery of high quality palliative and end of life
care. Each domain contains four levels of knowledge and skills. The framework
promotes a person-centred, outcomes-focused, human rights-based approach.
Conclusions: Integration of health and social care in Scotland means that
increasingly teams from different sectors are coming together to provide care
and support focussed on people’s needs. The scope and depth of workforce
engagement undertaken is a strength of this framework which will support
implementation across integrated services.

Football and Absent Friends

Author

Jeanette Byers

Health Promoting Palliative Care Project
worked in collaboration with Hibernian Football Club GameChanger Project to
host a 'To Absent Friends' event during November 2017, as part of the wider
national To Absent Friends Festival. Response from fans was overwhelmingly
positive, with over 500 personal tributes collated on posters that were
available in the stadium. This demonstrated the value of promoting openness
about bereavement in a community setting that is not routinely associated
with end of life matters.The concept is based on community development
principles and fits in with Public Health Palliative Care values. The method was
simple: provide information about the proposed event on the fans website,
then put up posters/pens/BluTack) around the stadium over 2 match days. 130 x
A3 sheets are now being preserved in the Club's museum, and a similar event
will be run annually by the Club. Scottish Football League Trust is promoting
this concept to 42 clubs across Scotland.

Hospital Based Complex Clinical Care

Authors

Jeanette Byers; Mairi Johnston

Palliative Care Specialist Nurse and
Palliative Link nurses organised an event for ‘To Absent Friends’ (TAF) week.
On the 1st November, tables were set up in 5 hospital areas with resources
provided by Health
Promoting Palliative Care Project (leaflets, memory books, memorial trees, TAF posters, pens
etc). Each area was manned for 2 hrs in the afternoon. This allowed communication with staff,
patients and visitors so that displays could be introduced sensitively. Staff
and visitors were given the opportunity to write in the book or write tags to
hang on the tree. One ward area now offers the memorial book all year round
for patients and visitors to use.Following on from the success of this event,
the group was keen to further develop its knowledge and skills around health
promoting palliative care so workshops were facilitated by Specialist
Palliative Care Nurses and the Health Promoting Palliative Care project team. This included workstations where
link nurses could become familiar with resources such as Advanced Care
Planning cards and Origami. There was also time for discussion and reflection
on professional and personal experiences of death, dying and bereavement. Qualitative data is available from written
material and verbal feedback, demonstrating the value of supporting staff as
they encourage open discussion about end of life issues within their hospital
environment.

Implementing Palliative and End of Life
Care Standards in Scottish Prisons

Author

Gail Allan

Background:
The
Scottish Government’s Strategic Framework for Action on Palliative and End of
Life Care shares a vision where palliative and end of life care is available
to all including those in Prison. With an ageing prison population, the
Scottish Prison Service has to deal with more foreseeable deaths than ever
before. This brings new challenges for both prison regimes and prison
facilities in providing quality palliative and end of life care for those
prisoners.Aim: Initial aims of
project: 
introductory visits to meet with Prison service and NHS
staff to discuss role and introduce them to the standards of care 
identify prison establishments willing to participate in
tests of change
work collaboratively with these prisons to identify their
palliative population and areas for improvement.Early Results:
delivered sessions on ‘What is palliative and end of life
care?’ 
developed Palliative and Supportive Care registers 
support development of multidisciplinary prison
palliative care meetings 
delivery of Anticipatory Care Planning training to prison
and NHS staff
process mapping of palliative and end of life service
provision in key establishment to bench mark against standards of care and
evaluate further areas of change.

Inheritance Books and Health Promoting
Palliative Care at the Edinburgh International Book Festival

The Edinburgh International Book Festival
attracts audiences from around the world. This year, the Scottish Partnership
for Palliative Care, St Columba's Hospice Edinburgh and Marie Curie Hospice
Edinburgh were offered space there for a weekend. We used this in several
ways:a) Photographic exhibition: "It Takes a
Village" by Glasgow-based photographer Colin Gray in collaboration with
the Scottish Partnership for Palliative Care explores the idea that as people’s
health deteriorates, care and support come in many guises.b) Conversations: staff from both hospices
spoke to visitors and two "Death Lunches" were facilitated by staff
from Marie Curie Hospice.c) Information sharing: leaflets from Good
Life, Good Death, Good Grief and the new ‘origami game’ about Advance Care
Planning (SPPC) d) “Inheritance Books” people were invited to
note the title of a book they inherited or would like to pass on and why this
book means a lot. Completed postcards were displayed.e) St Columba's Hospice in Edinburgh Doors
Open Day (23 September 2017) – postcards advertising this were given to local
visitors.Our poster shares some “Inheritance Books”,
visitor feedback and our reflections on engaging in health promoting
palliative care at The Edinburgh International Book Festival.

Inspiring Leadership – Leading self; leading
others in a palliative care setting

Authors

Jane Miller; Susan Jackson; Fiona Wylie; Claire
O'Neill

Background: It is recognised
within Palliative Care (PC) that band 6 CNS’s, in particular newly appointed
staff have reported feeling vulnerable, stressed and struggling to deliver
high quality care due to organisational change and increasing complexity
around their role. To address the above an NHSGGC PC Leadership Steering
Group was established in partnership with NES Leadership Unit.

Aims:

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Provide a pilot leadership training programme open to
band 6 PC CNS’s working within NHSGGC acute and hospice care settings